The effectiveness of mindful parenting programs in promoting parents' and children's wellbeing: a systematic review.

Abstract

The rationale for undertaking this review was to investigate a potential strategy to address the rising prevalence of child and adolescent mental health disorders. The central tenants of mindful parenting appear to be emotional awareness, emotional regulation, attention regulation, intentionality and non-judgmental acceptance. The primary objective of this review was to systematically evaluate the effectiveness of mindful parenting programs in promoting children's, adolescents' and parents' wellbeing, particularly in relation to the intensity of symptoms associated with internalizing (depression, anxiety, stress) and externalizing (conduct) disorders. The secondary objective was to evaluate how effective mindful parenting programs are in improving emotional regulation, attention regulation, quality of the parent-child relationship, resilience and mindfulness of the children, adolescents and parents. Children aged between 0 and 18 years and their parents who have completed a mindful parenting program were the focus of this review. Mindful parenting programs included in this review had a minimum duration of one to two hours per week for 6 to 8 weeks, delivered in a group format, by a facilitator with appropriate training. It included parenting programs that drew upon mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-based cognitive behavior therapy, dialectical behavior therapy or acceptance commitment therapy. The comparator was the control or waitlist conditions. This review focused on randomized controlled trials evaluating the effectiveness of mindful parenting programs. Primary outcomes were wellbeing or intensity of symptoms associated with internalizing disorders (depression, anxiety, stress) and externalizing disorders (conduct disorders) in children, adolescents and parents. Secondary outcomes were emotional regulation, quality of the parent-child relationship, resilience and mindfulness of the children, adolescents and parents. Eight databases were searched for studies evaluating mindful parenting programs from 1997 to November 2014. A three-step search strategy was utilized to retrieve both published and unpublished studies written in English from PubMed, PsycINFO, EMBASE, Scopus, Psychological and Behavioral Sciences Collection, CINAHL, Cochrane Library and ProQuest Dissertations and Theses databases. A logic grid was developed for each of the eight databases to identify the indexing terms and synonyms for the keywords "mindful" and "parenting". Methodological limitations included small sample sizes leading to lack of statistical power, multiple testing leading to increased alpha errors in addition to information bias caused by a lack of blinding in the implementation and assessment phase. The data extraction process entailed using the standardized data extraction form from Joanna Briggs Institute Meta-analysis of Statistics Assessment and Review Instrument to extract data from the selected studies. The heterogeneity of the samples, the measurement tools and outcomes measured precluded data synthesis through meta-analysis. Conclusions on intervention effects were based on comparisons of the overall statistical significance of the outcomes data. The search yielded 1232 articles, from which seven randomized controlled trials met the inclusion criteria. The findings indicate mindful parenting programs may reduce parental stress, increase parents' emotional awareness of their 10-14-year-old children and reduce preschool children's symptoms associated with externalizing disorders. A recurring finding was that the mindful parenting programs reduced parents' emotional dismissal of their adolescents and preschoolers. At present, there is insufficient evidence to conclude that mindful parenting programs can improve parents' and children's wellbeing because of the methodological quality of the few studies that met the inclusion criteria. Although there is currently insufficient evidence, mindful parenting programs are increasingly used in a variety of contexts. It may not be appropriate for psychotic or severely traumatized individuals. Future studies could make a significant contribution to the field by designing studies with sufficient sample sizes, adequate statistical power as well as blinding participants, facilitators and assessors.